Billing > Facility Billing

Mental Health Billing

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Angie:
If a non participating Residential Treatment Facility for Mental Health gets an authorization from an insurance company to cover x amount of days and then they deny after so many days; Can the facility have an insurance rate that they bill the insurance (400.00 a day) and then once the insurance stops funding and it goes to strictly private pay, can they charge the patient a less amount (300.00) due to discounts they offer for no insurance coverage?
Can they have an insurance rate and then a private pay rate after the insurance will no longer fund?

Michele:
You are not supposed to charge a different rate for insurance patients than you are for self pay.  There are ways to offer discounts, etc but you need to make sure you are not breaking any state or local laws.

Angie:
Even though the daily rate is $400.00 in the contract and then there is an addendum to the contract for $300 for an underinsured daily rate of $300? It is a discount that the facility provides to uninsured clients just as a Dr. would for an office visit if you don't have insurance?

PMRNC:
The proper way to show this is to putt full charge and SHOW the discount using a discount adjustment code. This way if ever patient submits it they have the full charge and you have done nothing wrong because the discount has been shown/disclosed.

Angie:
So if we bill the insurance for the full rate of 400.00 a day for 10 days they have authorized  (we are not contracted so they are going to pay what they are going to pay) and then after the 10th day they are not going to pay anymore, we can bill the parents the uninsured rate (discount) of $300 and just show the $100 adjustment, correct?
Thank you for all your helpful information! It is like Christmas morning when I go to click on show new replies to your posts and there is information there ;D

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